Adequate Staffing

I work on a "pediatric" unit. We also take general med/surg paitents when our pediatric census is low, which is most of the time. I can only remember a couple of times that we had all pediatric patients. This also means my patient load can include a 3 day old and a 93 year old. We do primary care. Day shift uses a charge nurse, who does orders, talks to the doctors, etc, but then the other nurses do all of their own care and meds, etc. There is a mix of LPNs and RNs. The charge nurse also does IV push meds or hangs blood if necessary for the LPNs. On second shift we do primary. Someone is appointed "charge" but basically does the patient assignment, assigns beds, etc. We all do primary care, the RNs do their own orders and assessments. Depending on how many LPNs are working, either the "charge" nurse will do whatever they can't do or if there is more than one we will sometimes make "teams" where each RN will team with an LPN and do their pushes, etc. Generally though we all get along well and will pitch in. I have no problem giving a push med for most of the LPNS I work with and some will offer to give PO meds for me in exchange if we are busy. It used to be that one person would make a med list and check meds for the floor while we were in report. Originally it was the charge nurse, then it was whoever had time during report, but things started getting missed and we all started having our own med book and checking our own meds. All of this worked fairly well when we were averaging 12 - 15 patients on the floor. Lately our census has been closer to twenty patients and I honestly think we need to reevaluate how we do things.

Friday I arrived at work to find the census at 21. It was myself and another RN who was scheduled 3p-3a. We just kept looking at each other like, is it just us??? We were joined by an agency nurse who had been a psych nurse for 20 years and has just returned to hospital nursing, and an RN & TECH from the NICU who did our vital signs and basically were our nurses aides. We each had 7 patients. It was horrible. I felt like all I did was go from room to room putting out "fires". Meds were late, I wanted to lock the doors so no more doctors could come through the door. My patients included one who was getting platelets, one with an ileus who had an NG draining large amounts. A patient that had to be turned every hour and was still breaking down, because he was end stage (fill in about 7 diagnoses here), was on a 100% NRB, tubefeeding, etc..and I had a hard time dealing with emotionally because I felt he should be on hospice. A man who had just been diagnosed with an abdominal mass. One of the other RNs had a patient getting blood, I honestly don't know how the agency nurse made out, she asked a few questions at the beginning of the shift and I really didn't see much of her after that.

Last night was much better. We had 23 patients when I started the shift, 3 RNs and an LPN, then they sent us another RN and we had an RN from the NICU again acting as an aide. I ended up with a 4 patient assignment and one was discharged, I thought I died and went to heaven .

Sue

33 bed med surg unit: typical staffing when full is 5 RN, 2 LPN (days and nights), with 4 NA on days, 2 NA on eves and 1-2 NA on nights. Sometimes go with 3 RNs and 3 LPNs if there aren't 5 RNs available.

LPNs do assessments, PO meds etc. RN only can do admissions, IVs and orders.

27 bed cardiothoracic surgical PCU (also w/ some general telemetry)

on days

7 RN's, 3 NA's, 2 sec/monitor tech.